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Care Management

Our care management applications support the medical management activities conducted across the care continuum. Health plans, employers, and third-party administrators optimize member outcomes enabled by tools that support case management, disease management, population health, utilization management, advocacy, and wellness programs.

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Absolute Transparency into the Cost and Quality of Care

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Case Management

Case managers utilize our applications to focus on care coordination, financial management and resource utilization to yield cost-effective outcomes that are patient-centric, safe and provided in the least restrictive setting. Our case management tool-set enables nurses and other licensed professionals to meet health outcome and cost containment goals under value-based care and payment agreements.

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Utilization Management

Plan administrators can monitor authorization requests (inpatient, services and pharmacy) for all plan members. The application serves as the source of truth for all attachments sent by the provider for the request. Other features include: the ability to conduct initial authorization and continued stay reviews for inpatient authorizations; the ability to do approval, denial, carve outs of days requested; the ability to link directly to evidence based criteria from InterQual or MCG; the ability to communicate/document on secondary reviews; the ability to generate letters of decisions to multiple places (member, provider, facility) based on business needs; and the ability to handle appeals and grievances.

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Cohort Management

Effectively and proactively coordinate care with 360° member views and built-in clinical insights, including gap-in-care alerts and risk scores to support early identification and intervention of at-risk members of the cohort. Cohorts of members that meet certain criteria can be created (in Plan Analytics) and monitored in real time (from Plan Analytics or the care management application). Cohorts can be imported and auto-assigned into queues. Queues can be set up to automatically trigger actions, such as a significant next action, or a program referral for members of the cohort. One example of this would be for all members with diabetes in a cohort to be automatically referred to or enrolled in a diabetes management program.

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Incentives & Rewards

Patient-Member engagement can be managed by administering incentive-based programs, tracking progress towards goals and allocating rewards upon completion. The incentive management application is shared between the member and the care team, so everyone is aligned around the care plan, the member’s goals, and progress towards them.

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Provider Portal

The Provider Portal allows providers to submit requests for inpatient, service/procedure and pharmacy authorizations for a member. Once submitted, the request is acted on by the care management team member and the requesting provider receives a response indicating whether the response is approved, pending, or denied. The provider can view both current and historical information on submitted and completed authorization requests related to the member.

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Member Portal

Those responsible for improving health outcomes need a simple way to proactively manage member health across the entire spectrum of care. The member Health Portal serves as an extension of Plan Analytics, seamlessly integrating and organizing healthcare data to deliver individualized information that supports members in taking action to meet their personal health goals and allows for more effective member communications.

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Eligibility Management

Experience a faster, easier and more complete way to verify eligibility with automated verification using a unique real-time batch process through direct and gateway connections to payers.

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Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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employers

Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Empower your team with timely information to take action and reach performance goals.

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Transform the way you report on your business with these intelligent tool sets.

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Manage patients effectively from chronic conditions to transitions of care.

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Administer retrospective and prospective bundled payment arrangements with clinical excellence.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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